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Prevalence of Joint Gait Patterns Defined by a Delphi Consensus Study Is Related to Gross Motor Function,
Angela Nieuwenhuys1, Eirini Papageorgiou1, Simon-Henri Schless1
1Neuromotor Research Group, Department of Rehabilitation Sciences, KU LeuvenLeuven, Belgium.
Insights
A new joint gait classification for children with cerebral palsy (CP) shows construct validity. Minor gait deviations were most common, linked to lower spasticity and better muscle strength in CP patients.
Area of Science:
- Orthopedics and Rehabilitation
- Pediatric Neurology
- Biomechanical Engineering
Background:
- Cerebral palsy (CP) significantly impacts gait in children, necessitating accurate classification systems.
- A previously developed joint gait classification system for CP demonstrated reliability and content validity.
- The current study investigates the construct validity and clinical relevance of this established CP gait classification.
Purpose of the Study:
- To assess the construct validity of a new joint gait classification system for children with cerebral palsy (CP).
- To explore the clinical relevance of the identified joint gait patterns in relation to patient characteristics and clinical symptoms.
- To provide initial insights into how the classification system distinguishes clinically relevant subgroups within the CP population.
Main Methods:
- Retrospective analysis of 286 children with spastic CP (ages 3-18, GMFCS levels I-III).
- Classification of 3D gait analysis kinematic and kinetic trials into 49 distinct joint patterns.
- Statistical analysis (Pearson Chi square, Cramer's V) correlating joint patterns with patient characteristics and clinical measures (spasticity, muscle weakness).
Main Results:
- Patient-specific characteristics showed significant but generally weak associations with joint gait patterns.
- Minor gait deviations were the most frequent patterns, particularly in limbs with lower spasticity and good muscle strength.
- Pathological patterns like 'outtoeing' and 'intoeing' showed moderate associations with muscle weakness and spasticity, respectively.
Conclusions:
- The joint gait classification system demonstrates construct validity by associating with clinical factors in children with CP.
- The system can differentiate clinically relevant subgroups, with minor deviations being prevalent in less impaired limbs.
- Further validation is recommended, but the system shows promise for clinical application in CP gait assessment.
Abstract:
During a Delphi consensus study, a new joint gait classification system was developed for children with cerebral palsy (CP). This system, whose reliability and content validity have previously been established, identified 49 distinct joint patterns. The present study aims to provide a first insight toward the construct validity and clinical relevance of this classification system. The retrospective sample of convenience consisted of 286 patients with spastic CP (3-18 years old, GMFCS levels I-III, 166 with bilateral CP). Kinematic and kinetic trials from three-dimensional gait analysis were classified according to the definitions of the Delphi study, and one classified trial was randomly selected for each included limb (n = 446). Muscle weakness and spasticity were assessed for different muscle groups acting around the hip, knee, and ankle. Subsequently, Pearson Chi square tests, Cramer's V, and adjusted standardized residuals were calculated to explore the strength and direction of the associations between the joint patterns, and the different patient-specific characteristics (i.e., age, GMFCS level, and topographical classification) or clinical symptoms (muscle weakness and spasticity). Patient-specific characteristics showed several significant associations with the patterns of different joints, but the strength of most identified associations was weak. Apart from the knee during stance phase and the pelvis in the sagittal plane, the results systematically showed that the patterns with "minor gait deviations" were the most frequently observed. These minor deviations were found significantly more often in limbs with a lower level of spasticity and good muscle strength. Several other pathological joint patterns were moderately associated with weakness or spasticity, including but not limited to "outtoeing" for weakness and "intoeing" for spasticity. For the joints in the sagittal plane, significantly stronger associations were found with muscle weakness and spasticity, possibly because most of the evaluated muscles in this study mainly perform sagittal plane motions. Remarkably, the hip patterns in the coronal plane did not associate significantly with any of the investigated variables. Although further validation is warranted, this study contributes to the construct validity of the joint patterns of the Delphi consensus study, by demonstrating their ability to distinguish between clinically relevant subgroups in CP.
